Takeaway
Grief without closure—when someone is physically present but cognitively or emotionally unreachable—is a major challenge. Support families by naming this experience and asking what the patient was like before illness.
Lifelong learning in clinical excellence | June 3, 2026 | 2 min read
By Nettie Reynolds, MDiv, interfaith chaplain
Harold’s wife sat beside her husband’s ICU bed watching his face for signs of recognition. Each of his movements seemed to carry meaning. A twitch beneath sedation. A slight squeeze of the hand. A change in expression that might have been recognition or might have been reflex.
I was working as a hospital chaplain in an ICU where some patients remained for weeks after catastrophic illness or injury. Harold had survived the initial crisis, but after prolonged sedation, delirium, and neurological complications, we weren’t sure what recovery would mean. His wife wasn’t only wondering whether he would live—she was trying to understand whether the man she knew would return to her.
Ambiguous loss
Family therapist Dr. Pauline Boss describes this experience as ambiguous loss: grief without clear resolution or closure. Families may experience this when a loved one remains physically present but becomes emotionally or cognitively unreachable through severe illness, brain injury, prolonged unconsciousness, or dementia. Unlike death, ambiguous loss offers no clear ending and families can feel suspended between hope and grief at the same time.
The vigil keeper
During Harold’s hospitalization, his wife became what many ICU clinicians recognize as a “vigil keeper.” She rarely left the room. She monitored numbers on screens, watched for changes in his breathing, and searched constantly for signs of improvement. She was exhausted, hypervigilant, and emotionally overwhelmed.
In critical care settings, healthcare professionals can unintentionally focus so heavily on survival that we miss the emotional reality families carry. Families aren’t only waiting for lab results or prognostic updates—they’re also trying to understand whether the person they love still recognizes them, remembers them, or can meaningfully return to shared life.
Grief without resolution
I sat with Harold’s wife after a difficult meeting with the medical team. “I feel like I’m losing him over and over again,” she said. There was nothing I could say that would remove the uncertainty of her situation—but I could acknowledge the loneliness of carrying grief without resolution.
One of the small things I often encouraged families to do was leave the hospital for a little while. Go home and shower. Walk outside in the sun. Get a cup of coffee. Many felt guilty stepping away from the bedside, even briefly, as though vigilance itself could protect the person they loved. But prolonged ICU stays place families under enormous physical and emotional strain. The body eventually absorbs what the mind is trying to survive.
Families in prolonged ICU settings teach us that grief doesn’t always begin after death. Sometimes it begins much earlier, in the painful space between physical presence and uncertain return.
Here are three things clinicians can do to support families experiencing ambiguous loss:
1. Remind loved ones to care for themselves physically.
Gentle reminders to shower, step outside, rest, or get something to eat are not small things.
2. Name it.
Naming ambiguous loss can help families feel less isolated and reassure them that anticipatory grief and emotional confusion are normal responses to prolonged uncertainty.
3. Ask about the person beyond the patient.
Questions like “What was Harold like before all of this?” help families reconnect to identity and relationship—not just illness.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.